Latest on the ACA in Utah

UHPP has tracked the ACA in Utah since day one.
Here is our latest report and analysis.

Download a PDF slideshow of this information here (pdf)

Enrollment

Utah ACA Enrollment (2013-2016) 

Facts: Utah enrollment in ACA health plans continues to 
grow overall, and especially in Utah and Washington Counties. Sign-ups reached 175,637 at the end of the open enrollment period on January 31. This represents a 25% increase from the prior year. Utah was the second-highest state in the nation for growth in ACA enrollment (behind Oregon). However, enrollment in AC A declined in 2015-16 in several rural counties, including Grand and Carbon counties.
Analysis: This rural county decline was likely due to the withdrawal of Arches Health Plans, the co-op insurer that the Utah Insurance Department shut down in October 2015. Arches was a popular plan choice in rural counties due to their low premiums, innovative offerings (no accident deductibles), and provider and hospital networks that extended to Grand Junction, CO.

ACA Marketplace Plans (2014-2016) 

Facts: Utah's marketplace lost three insurers in 2016 
(Arches, Altius, and Bridgespan), and gained one insurer (University of Utah Health Plans). The number of marketplace insurers varies by county. For 2016 Salt Lake County has four marketplace insurers offering a total of 74 plans, a decline from six insurers offering 101 plans in 2015. This year residents of Washington County and 19 rural counties have only one marketplace insurer (Select Health) offering 40 plans.
Analysis: Utah’s population is concentrated along the Wasatch Front, where residents have a choice of three to four marketplace insurers. However, the loss of Arches reduced choice for rural residents. Fortunately, premiums were not affected because Arches exited the marketplace after 2016 rates had been set. UHPP has confirmation from the Utah Insurance Department that new insurers plan to offer plans in Utah’s rural counties in 2017, increasing the competition and choice for consumers.

Utahns Receiving ACA Subsidy (2016) 

Facts: 85% of Utahns selecting a plan on healthcare.gov 
receive a premium subsidy to reduce their monthly 
premiums. The average monthly subsidy in Utah covers 68% of premium costs. According to the Kaiser Family Foundation’s 2015 Employer Health Benefits Survey, workers with job-based- health insurance receive pre-tax contributions from their employers equal to an average of 82% of their premiums for single coverage, and 71% for family coverage. [Kaiser Family Foundation; 2015 Employer Health Benefits Survey; Summary of Findings, page 1; http://kff.org/report-section/ehbs-2015-summary-of-findings/]
Analysis: The premium subsidies created by the ACA mimic the employer contributions that most private and public sector employees receive. In Utah, ACA subsidies cover a smaller percentage (68%) of insurance premium costs than the average employer single and family contributions (82%, 71%).

Facts: 59% of Utahns selecting an ACA plan earn under 200% of the federal poverty level. 21% of Utahns earn between 200% and 250% of the poverty level. Nationally 15% of enrollees earn between 200% and 250% of the poverty level

ACA Subsidies & Enrollment by FPL 

Analysis: Utah has a much higher percentage of moderate income enrollees earning between 200% and 250% of the poverty level. Any children of this sub-group are enrolled in ACA insurance because they earn too much to qualify for Medicaid or CHIP.

Facts: In addition to premium subsidies, Utahns earning between 100% and 250% of the federal poverty level receive cost-sharing assistance to reduce the burden of co-pays and deductibles for their insurance. These tax credits and cost-sharing reductions are only applied to Silver, Gold, and Platinum-level plans. For instance, the annual deductible for a benchmark Silver plan purchased by a 30-year old Salt Lake City resident would normally be $3,800 without cost-sharing reductions. But if the same individual earned 175% of the poverty level, not only would that person receive a monthly tax credit of $135, but their deductible would be reduced to $900.
Analysis: One of the major criticisms leveled against the ACA is that consumers can only purchase high-deductible insurance. Facing these high deductibles, consumers are less likely to actually use or retain their coverage. However, deductibles have been rising in individual market and employer-based insurance for over a decade. In 2006, 10% of all employers offered insurance plans with deductibles more than $1,000 for single coverage. By 2012, two years before the implementation of the ACA, that percentage had risen to 34%. As of 2015, 46% of all firms offered insurance plans with deductibles more than $1,000 for single coverage. Similar trend lines occurred in private market insurance. The ACA offers a diverse choice of insurance options for consumers—ranging from HSA-qualified, high-deductible, lower-premium Bronze plans, to low-deducible, higher-premium Gold and Platinum plans. The choices for a 30-year old in Salt Lake County range from a Bronze plan with a HSA-qualified $5,000 deductible ($205 per month), to a Platinum plan with a $250 deductible ($436 per month).


Demographics


Facts: 24% of Uthans signing up for an ACA plan are children age 0-18, representing 42,000 children. Utah's child enrollment rate is 2.67x the national average. 

ACA Enrollment by Age (2016) 

Analysis: Utah's under-18 population is 7.7 percentage points (or 1.33x) higher than the national average. Yet Utah's under-18 ACA enrollment percentage is 15 percentage points (or 2.67x) higher than the national average. This means that Utah’s under-18 population is enrolled in ACA health insurance at a higher rate than predicted by the state’s younger skewed population. In addition, most of the Utah children enrolling in ACA insurance come from middle and upper-income families earning between 200% and 400% of the federal poverty level. That's because children in families earning under 200% of poverty are enrolled on Medicaid or CHIP. In real dollar terms, the range of 200% to 400% of the poverty level represents $56,000 to $113,640 for a family of five.

Facts: 71% of Uthans signing up for an ACA plan are under 45 years old. Nationally, 51% of enrollees are under 45 years old.

Snapshot of ACA Coverage In Utah 

Analysis: Utah has the youngest population of any state. Still, Utah's under-45 enrollment is much higher than is predicted by Utah’s demographic characteristics. Younger Utahns are signing up for ACA insurance at a higher rate than other states.

Geography
Facts: Utah ZIP Codes with the highest number of plan selections are in Lehi, South Jordan, American Fork, Pleasant Grove, and St. George. Utah ZIP Codes with the fastest enrollment growth between 2015-16 are in Spanish Fork (+24%), Orem (+24%), Riverton, (+23%), Provo (+22%), and Herriman (+20%).

ACA Enrollment by Utah ZIP Code (2016) 

Analysis: Utah County has led the state's enrollment growth for the last two years. The epicenter of ACA enrollment has steadily moved southward from West Valley City and South Jordan (2014) to Lehi and American Fork (2015) and now to Orem and Spanish Fork (2016). St. George experienced a surge in ACA enrollment (+50%) in 2015 that subsided to a moderate 10% increase in 2016. Based on reports from local navigators, the Utah county enrollment surge is fueled by married students (BYU, UVU), self-employed workers and their families, start-up employees, sales and commissioned-based workers. Enrollment in Utah County is dominated by middle-income families who sign up together for the same plan and receive significant premium subsidies. Enrollment in Weber, Davis, and Salt Lake counties reached a saturation point in 2015 and is now governed by normal churn and is less dynamic.